劇症肝不全に対するアフェレシス治療の適応と限界(<特集>劇症肝炎の治療をめぐって)  [in Japanese] Indications and Limitations of Plasmapheresis for Fulminant Hepatic Failure  [in Japanese]

The artificial liver support system is being tested for clinical trials this century. The standard treatment for fulminant hepatic (FH) is liver transplantation. In the US and Europe, cadaveric liver transplantation is a routine procedure. On the other hand, in Japan, living-donor liver transplantation has been performed mainly due to the limitation of cadaver organs. The management of the FH patient is initially to support liver function until the time when the donor organ is available in the US and Europe. Therefore, artificial liver support in clinical trials has been used as a bridge for liver transplantation. However, Japanese doctors mostly treat FH patients much longer than the bridging time reported in literature. In our hospital, continuous plasma exchange (CPE) +continuous hemodiafiltration (CHDF) has been used for FH patients. We have not yet conducted controlled trials of CPE+CHDF treatment for FH patients. However, in this setting, survivors have shown low hepatocyte growth factor (HGF) levels and high alpha feto-protein (AFP) levels. All FH patients who presented more than 0.76 points of LHL 15 in 99mTc-GSA hepatic scintigraphy survived. Although an artificial liver support system has not been completely established, some challenging treatments of plasmapheresis seem to be effective. The problem is that there is no marker for evaluating liver function and regeneration. Once we have one, it may contribute not only to clinical treatment, but also medical economics.